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Congress urged to rein in surprise 'out-of-network' medical bills

By:
Jamie Dupree

Updated: Jun 12, 2019 - 11:55 AM

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Congress urged to rein in surprise 'out-of-network' medical bills

Bemoaning a health insurance system that one lawmaker said is "really messed up," a U.S. House panel was urged Wednesday to find a legislative solution to help prevent consumers from being hit with large surprise medical bills, especially ones which arrive after hospital stays or emergency room visits, because the services were considered 'out-of-network' for insurance coverage.

One woman described how the discovery that her newborn son had hemophilia after a circumcision led to one night of treatment in the hospital’s Newborn Intensive Care Unit - and then a surprise bill.

"Opening the mail, we found a bill for $50,000 for Thomas’s stay in the NICU," said patient advocate Sonji Wilkes. "My husband and I were dumbfounded. We had been in an in-network facility. How could we possibly be responsible for that amount?"

Wilkes told lawmakers that it turned out the NICU was not run by the hospital - but had been subcontracted to a third party provider, which was not part of their insurance network.

"The bill was not itemized at all," Wilkes said. "It was just a dollar amount."

Sonji Wilkes, a patient advocate testifying on #SurpriseMedicalBills today, received an unexpected bill for $50,000 from an out of network provider in the NICU after her son was born. Her hospital & doctor were in network and she had no reason to believe the NICU was otherwise.

"I think this is nuts," said Rep. Greg Walden (R-OR). "This is going on every day in America."

While doctors who testified before the House Energy and Commerce Committee on Wednesday said they obviously don't like the endless stream of stories about surprise bills, they argued their focus is on care, not the intricate details of an individual's health insurance plan, especially when it comes to emergency room treatment.

"In a medical emergency, getting treatment as soon as possible is the number one priority – not verifying which providers are in-network, figuring out how much your deductible is, or worrying how much treatment will cost, said Dr. Vidor Friedman.

"I happen to work in Orlando, Florida, at the hospital closest to Disney World," Friedman added. "Forty percent of my patients come from out of state - so forty percent of my patients are out-of-network."

The main goal of the plan is to hold patients harmless - especially in emergency situations - and increase the amount of transparency governing how patients are billed for what medical services.

"Our number one recommendation is not to wait," said Claire McAndrew with Families USA. "This legislation must pass this year."

Studies have shown that about 20 percent of all visits to an emergency room draws a surprise medical bill, but there is also evidence that inpatient hospital care can bring billing surprises as well, along with air ambulance services.

Air ambulance, the ultimate surprise medical bill. Gary Burns was billed $28,227 for a medevac flight, but only $5,775 was covered by insurance. https://t.co/zMfr9O9YUI